A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

Bayón, Cristina; Lorenzo, Teresa Martín; Moral-Saiz, Beatriz; Ramírez, Óscar; Pérez-Somarriba, Álvaro; Lerma-Lara, Sergio; Mastro-Martínez, Ignacio; Rocón, Eduardo

doi:10.1186/s12984-018-0412-9

Cited by 59 publications

(57 citation statements)

References 34 publications

(34 reference statements)

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“…A previous study reported the strengthening of lower extremity muscles after RAGT [ 43 ]. Although lower extremity muscle strength was not measured in this study, participants reported mild muscle soreness in the lower extremity after training, suggesting that untethered overground RAGT enabled active use of lower extremity muscles.…”

Section: Discussionmentioning

confidence: 99%

Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

Kim

Park

Yoo

et al. 2021

Sensors

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The untethered exoskeletal robot provides patients with the freest and realistic walking experience by assisting them based on their intended movement. However, few previous studies have reported the effect of robot-assisted gait training (RAGT) using wearable exoskeleton in children with cerebral palsy (CP). This pilot study evaluated the effect of overground RAGT using an untethered torque-assisted exoskeletal wearable robot for children with CP. Three children with bilateral spastic CP were recruited. The robot generates assistive torques according to gait phases automatically detected by force sensors: flexion torque during the swing phase and extension torque during the stance phase at hip and knee joints. The overground RAGT was conducted for 17~20 sessions (60 min per session) in each child. The evaluation was performed without wearing a robot before and after the training to measure (1) the motor functions using the gross motor function measure and the pediatric balance scale and (2) the gait performance using instrumented gait analysis, the 6-min walk test, and oxygen consumption measurement. All three participants showed improvement in gross motor function measure after training. Spatiotemporal parameters of gait analysis improved in participant P1 (9-year-old girl, GMFCS II) and participant P2 (13-year-old boy, GMFCS III). In addition, they walked faster and farther with lower oxygen consumption during the 6-min walk test after the training. Although participant P3 (16-year-old girl, GMFCS IV) needed the continuous help of a therapist for stepping at baseline, she was able to walk with the platform walker independently after the training. Overground RAGT using a torque-assisted exoskeletal wearable robot seems to be promising for improving gross motor function, walking speed, gait endurance, and gait efficiency in children with CP. In addition, it was safe and feasible even for children with severe motor impairment (GMFCS IV).

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Section: Discussionmentioning

confidence: 99%

Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

Kim

Park

Yoo

et al. 2021

Sensors

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“…Given the constraints of remote rehabilitation, ways to capture interest, especially in pediatric patients, warrants further investigation. For example, robotic rehabilitation has been applied to patients with cerebral palsy by combining it with video games (Figure 2) [8]. Children's National Hospital reported the start of an at-home robotic rehabilitation program in the fall of 2020.…”

Section: Telehealth In Rehabilitationmentioning

confidence: 99%

A Symposium on the Clinic of the Future and Telehealth: Highlights and Future Directions

Carpenter

Sheppard

Atabaki

et al. 2021

Cureus

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Children's National Hospital held a virtual symposium on "The Clinic of the Future and Telehealth" in December 2020. The goal of the symposium was to explore future trends in these domains. We also discussed how the coronavirus disease 2019 (COVID-19) pandemic accelerated ongoing changes in healthcare. We explored what is on the horizon in these fields and how these changes might affect care delivery in the future. Specifically, we discussed the "Clinic of the Future" with clinical teams from genetics and metabolism, orthopedic surgery, and primary care while our telehealth discussion involved genetics and metabolism, psychiatry, and telerehabilitation. As one example, wearable technology could be adopted among primary care practices and drive a shift in outpatient care from center-based care to patient-based care. We also examined technological innovations in physical exam instruments, gait analysis, imaging integration, and cast technology that could modernize the orthopedic surgery clinic. Telemedicine has rapidly expanded among all fields of medicine, especially since the COVID-19 pandemic, and has spurred innovation to improve the effectiveness of virtual physician visits. The development of technology to improve the virtual physical exam, during a telemedicine visit, further increases the utility of online appointments and increases access to care in all specialties. The incorporation of photogrammetry technology, in genetics and metabolism dysmorphology exams, will offer standardized tracking of patients that could improve diagnosis and treatment. Psychiatry has found nearly equal efficacy in diagnosis and treatment with telehealth visits and the additional benefit of gaining insight in the setting of the patients' home. Robotics has become increasingly common in rehabilitation, which can now incorporate a gaming experience that can be remotely updated and increase engagement and adherence in pediatric patients. The continued exploration of new ideas promises to improve both in-person and virtual care options.

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“… 1 Yet, systematic reviews of RAGT do not provide evidence to support improved outcomes. 2 , 3 Potential reasons for the underwhelming results from these studies are the relatively limited intervention schedules (2–5 sessions per week, 25–60 minutes each, for up to 6 weeks) 3 , 4 and the absence of dynamic adaptable control systems that challenge the user and ensure active participation in rehabilitation. 4 Wearable exoskeleton technology offers the potential to address these shortcomings by providing daily bouts of overground gait training tailored to the individual user.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 Potential reasons for the underwhelming results from these studies are the relatively limited intervention schedules (2–5 sessions per week, 25–60 minutes each, for up to 6 weeks) 3 , 4 and the absence of dynamic adaptable control systems that challenge the user and ensure active participation in rehabilitation. 4 Wearable exoskeleton technology offers the potential to address these shortcomings by providing daily bouts of overground gait training tailored to the individual user. As an example, we previously developed a pediatric knee exoskeleton that alleviates crouch gait in children with cerebral palsy by using precisely timed knee extension assistance to dynamically change posture.…”

Section: Introductionmentioning

confidence: 99%

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An open source graphical user interface for wireless communication and operation of wearable robotic technology

Tucker

Hammel

et al. 2020

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction Wearable robotic exoskeletons offer the potential to move gait training from the clinic to the community thereby providing greater therapy dosage in more naturalistic settings. To capitalize on this potential, intuitive and robust interfaces are necessary between robotic devices and end users. Such interfaces hold great promise for research if they are also designed to record data from the robot during its use. Methods We present the design and validation of an open source graphical user interface (GUI) for wireless operation of and real-time data logging from a pediatric robotic exoskeleton. The GUI was designed for trained users such as an engineer or clinician. A simplified mobile application is also provided to enable exoskeleton operation by an end-user or their caretaker. GUI function was validated during simulated walking with the exoskeleton using a motion capture system. Results Our results demonstrate the ability of the GUI to wirelessly operate and save data from exoskeleton sensors with high fidelity comparable to motion capture. Conclusion The GUI code, available in a public repository with a detailed description and step-by-step tutorial, is configurable to interact with any robotic device operated by a microcontroller and therefore represents a potentially powerful tool for deployment and evaluation of community based robotics.

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A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

Cited by 59 publications

References 34 publications

Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

A Symposium on the Clinic of the Future and Telehealth: Highlights and Future Directions

An open source graphical user interface for wireless communication and operation of wearable robotic technology

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